Inspection on 29/06/06 for Winsford Grange Care Home

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Winsford Grange Care Home 27/10/08

Winsford Grange Care Home 15/04/08

Winsford Grange Care Home 10/04/07

Winsford Grange Care Home 22/09/05

Winsford Grange Care Home 27/04/05

Winsford Grange Care Home 14/10/04

Winsford Grange Care Home 17/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Winsford Grange Care Home Station Road Bypass Winsford Cheshire CW7 3NG Lead Inspector Helena Dennett Key Unannounced Inspection 29 June 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Winsford Grange Care Home Address Station Road Bypass Winsford Cheshire CW7 3NG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01606 861771 01606 861705 www.c-i-c.co.uk. Community Integrated Care Mark Laight Care Home 60 Category(ies) of Dementia (3), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (30), Physical disability (1) Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 60 service users to include: * Up to 30 service users in the category of OP (old age not falling within any other category * Up to 30 service users in the category of DE(E) (dementia over the age of 65) * Up to 3 service users age 60 years upwards in the categories of PD or DE * One named service user under the age of 65 in the category of PD The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 22nd September 2005 2. 3. Date of last inspection Brief Description of the Service: Winsford Grange is a purpose built facility. It comprises of two units: one for elderly frail service users and one for the elderly mentally infirm service users. Each unit has two wings of 15 beds each. Dickens and Austen are the wings accommodating the elderly frail service users, and Bronte and Chaucer the wings accommodating the elderly mentally infirm service users. The home is a single storey building with good access for wheelchairs. Bedroom accommodation comprises of 38 single and one double room. There are no ensuite toilet or bathroom facilities. There are private enclosed gardens. The home provides good car parking facilities, and is located on a local bus route, and is close to rail services. Registered nurses are on duty at the home at all times in accordance with statutory requirements. The fees range between £390 - £500 per week. Additional charges are made for hairdressing and aromatherapy. Further information can be obtained from the manager of the home. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection of this agency, considers events that have occurred since the last inspection. A questionnaire, designed to provide information about the home was sent from CSCI by post approximately six weeks before this site visit. This was returned promptly. Two inspectors visited the home on 3rd July 2006. They toured the building looked at a sample of records and spoke to residents and staff. The findings are incorporated into the body of the report. What the service does well: What has improved since the last inspection? The registered manager has resumed his position within the home and so the home is run in the best interests of the residents. Some improvements have been made to the care plans although further work is needed. Call bells have been installed in the lounge areas so residents can seek help immediately should an emergency arise. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 6 The management of medicines has improved and residents can be confident that they are receiving their prescribed medication. Improvements have been made to the road leading to the back of the home, which improves the health, and safety of staff and visitors to that area. There are now enough suitably qualified, competent, trained staff working at the home to make sure that the needs of residents are met. Staff are provided with a good induction programme and are supported in their training. All the necessary checks are carried out on staff before they are offered employment at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their needs assessed before they come into the home so that they are confident these will be met. EVIDENCE: A senior member of staff visits the prospective resident before they move into the home. They discuss their needs and how staff at the home will meet these. A pre admission document is completed and this is kept with the resident’s records at the home. The home does not have any intermediate care beds therefore standard 6 does not apply. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although residents were happy with the care they receive from staff at the home, some of the care plans do not provide staff with the information they need to meet residents’ needs and so there is a risk that residents health care needs may not be met. EVIDENCE: Four residents who spoke with the inspector made the following comments: ‘I am very happy with the care provided. Staff are good and look after me well. I have no complaints’. ‘I like it here, staff are nice, its comfortable’ ‘I know my main nurse and she has asked me about my interests. Staff are kind and caring’ ‘Staff are friendly and supportive, my privacy and dignity is respected’ Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 10 The manager confirmed that each resident had a care plan in place. Four residents records were looked at closely during the inspection. Two contained care plans that were based on individual needs. One record had a standard care plan in place. This did not give staff guidance as to how the individual needs of the residents would be addressed, and so there is a risk the resident’s needs may not be met in full. One resident is admitted regularly for respite care. The plan of care in place related to the residents previous visit. There was evidence that this persons needs had changed, however an assessment of needs was not done on this admission and new care plans were not developed. The member of staff who looked after the resident on the morning of the site visit knew the residents needs and recognised that these had changed since his last visit to the home. Staff complete risk assessments when residents are admitted to the home or when residents needs change. These include pressure sore risk assessments, nutritional risk assessment and bedside rail risk assessments. The risk assessments for bedside rails needs to be more detailed and some did not identify all the risks associated with their use. Residents said that staff maintain their privacy and dignity. However, on examining one residents care plan under personal hygiene it stated ‘wash the resident daily each morning while sitting on a commode’. A member of care staff confirmed that staff carried these instructions out each morning. This is considered poor practice that does not promote residents dignity. A thank you letter was sent to the home dated April 2006. This letter expressed gratitude to the staff for the approach taken that ‘allows residents to maximise their quality of life and maintain their dignity’. There was evidence that General Practitioners and other professionals are contacted as necessary. The arrangement for the management of medicines was inspected on Bronte and Austin Units. These have improved since the last inspection. A random stock check was taken and found to be correct. A medicines profile is kept for each resident, this identified current and past medicines prescribed. On Bronte Unit the Medicine Administration Record (MAR) sheets were difficult to read. Staff were advised to inform the chemist and request that these be improved upon. Records were satisfactory in the main, however a record was not make of the quantity of medicines carried over from one month to the next. On Austin Unit some of the MAR sheets were written by hand. It would be good practice for those staff making these entries to sign these and state their qualification. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities are well organised, providing a range of interests for people living at the home. Residents’ are enabled to exercise choice, giving them a degree of control over their lives. EVIDENCE: All of the residents who spoke with the inspectors said they were happy in the home. One resident was very happy with his room and the fact it looked out into the garden. It gave him a lot of pleasure looking at the birds and smaller animals that frequented the garden. Another resident said that staff had asked her what her hobbies and interests were and have tried to accommodate them. An activity co-ordinator is employed for 31 hours per week. The daily activity is displayed in the main entrance for all to see. Activities such as skittles, quiz, bingo, light gardening, film shows, karaoke and church services are organised regularly. In addition to visiting entertainers, trips out are also organised. Some residents went to see Ken Dodd recently, there are plans to take some residents to see Tony Christie at Delamere Forest. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 12 A policy on activation, interests and religion is in place. This states that residents should be supported in exercising their choice and that their cultural, ethnic and religious needs are catered for. Residents said that they can ‘suit themselves’ and that their individual needs are catered for. The home has an open visiting policy and residents confirmed that they could see their visitors in private if they so wish. One of the residents was due to celebrate their golden wedding on the day following the site visit. Staff at the home had arranged a buffet for the resident’s family. Residents were complimentary about the food that is offered at the home. Comments such as ‘the food is good’, ‘the food is great, plenty of choice’ were made. One resident said that the food is ‘improving’. Residents confirmed that staff ask the day before what they would like to eat for dinner the following day. Lunch on the day of the site visit appeared to be appetising with alternative meals offered. Diabetic diets are also catered for. A range of hot and cold drinks is served at mealtimes and tea and coffee with biscuits are provided mid morning and mid afternoon. Staff were seen assisting residents to eat at lunchtime. This was done with sensitivity. A calm relaxed atmosphere appeared to exist. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there is a complaints procedure in place, this was not followed for one complaint and so there is a risk that residents/relatives concerns may not be addressed. EVIDENCE: The home has a satisfactory complaints procedure that was on display. A shortened form of this was placed in all of the bedrooms. Two complaints have been recorded as being received at the home since the last inspection. Evidence was seen on how one complaint was dealt with. The second complaint was made in writing but there was no record available to indicate that this had been responded to by letter. Therefore it was not possible to find out the outcomes from the investigation. The home has a copy of the Department of Health’s document ‘No Secrets’ (this describes the form abuse may take and what actions should be taken if abuse is witnessed or suspected), that is available to the staff. As well as this, the home has its own policies on the protection of vulnerable adults and whistle blowing. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,24 &26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained, clean and tidy so residents live in a pleasant and safe environment. EVIDENCE: All four units were visited at this inspection and the majority of rooms were seen to be highly personalised by the residents or members of their families. All of the bedrooms are now for single use only, and are equipped with wash hand basins. The overall standards of décor and furnishings have been well maintained throughout the home. The external grounds were neat and tidy and the enclosed gardens on three of the units were planted with shrubs and flowering plants. The fourth garden is due to be upgraded in such a manner. All of the gardens accessible to the residents had a patio area and appropriate table and benches in them. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 15 Residents are provided with rise and fall beds that enable staff to care for them whilst in bed should they need this. A variety of hoists are provided throughout the home for moving residents who are unable to this for themselves. Staff were observed using this equipment in an appropriate manner. Alternating pressure relieving mattresses were fitted to the beds of residents who had been identified as being at risk of developing a pressure sore. The standard of cleanliness around the home was good. However, there was an unpleasant smell in two of the bedrooms on Chaucer Unit. When spoken with the cleaner said that she shampooed the rooms daily but met without success in eliminating these smells. Both of these rooms were currently unoccupied and the home manager was advised not to accommodate anyone in these rooms until the problem had been resolved. The home has only one sluice machine sited on Bronte Unit that disinfects commode pots. The other three units have sluice rooms that are equipped with open sinks where such equipment is washed after use. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough suitably qualified, competent and trained staff working at the home to make sure that the needs of the residents are met at all times. EVIDENCE: The home employs a team of registered nurses and care staff to assist with the delivery of care to the residents. A review of the staffing rotas showed that there are enough staff working to meet the needs of the residents. A team of ancillary staff are also employed at the home, i.e. maintenance, housekeeping, laundry, catering and administrative. Members of staff said that they felt they had more time to carry out their role as they now have enough staff working to meet the needs of the residents, particularly during the busy times in the morning. A sample of personnel records was examined. All of the necessary checks were done before staff were employed to work at the home. There are 44 care staff employed to work at the home. Sixteen have achieved a NVQ level 2 in care, and a further 10 staff are undertaking training, leading to this qualification. Staff who were spoken with said they felt supported in their role. They said that they go on training courses, which helps to develop their skills. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 17 All new employees do a four day induction training programme when they start work at the home. There were records of staff attending the following courses • Non violent intervention (8 staff) • Medicines training (1 staff) • Fire safety training ( 23 staff this year) • Basic food hygiene (2 staff since the previous inspection) • Trainers course in moving and handling (3 of the qualified nurses) • All of the registered nurses have received training in the management of syringe drivers. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an experienced manager in post, which means the home is managed well and is run in the best interests of the residents. EVIDENCE: The home manager is registered with the Commission for Social Care Inspection and has recently achieved an NVQ level 4 in management and care. Staff spoken with were positive in the style of management employed at the home. There is a good quality assurance system in place. The company has produced satisfaction survey forms for use by the residents. The manager said that every resident gets such a form four times a year. When filled in, the forms Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 19 are sent to an address in the South of England. Residents can choose whether or not they wish to be identified and where they live. If they do not it is not possible for the information to be collated in a meaningful way that reflects the home. The information informs the company as a whole. A representative of the company visits the home unannounced on a monthly basis. They speak with staff and residents, tour the building, review the complaints log, and other home records. A copy of their findings is kept at the home. There is a good system for the managing of peoples money in place. Families leave small amounts of money at the home for the purchasing of personal items for the residents, e.g. toiletries, hairdressing and trips out. An individual record is kept for each resident with receipts for any purchases made on their behalf. A check was made on the total amount of money kept and the records. These were found to be correct. Heath and safety systems in the home are satisfactory in the main. As detailed under standard 7 bed rails risk assessments need to be more detailed to ensure that all aspects of risk are identified. Records were seen of the fire alarm and emergency lighting systems being tested at regular intervals. A fire risk assessment for the premises was carried out in June 2005 and is now in need of updating. The home manager said that he was in the process of doing this. A gas safety certificate was seen that was valid up to August 2006. Records were seen of the portable appliances being safety checked in April 2006. Fire extinguishers were serviced in February 2006. Hoists were serviced in March this year, and are due for another service in September. A certificate dated 6th February 2006 for the disposal of waste products was seen. There was no record of the disinfection of the cold water system being carried out within the past twelve months. During the course of this visit the inspector spoke with someone in the company’s estates department who said that they would contact the firm contracted to carry out this work. The person from the estates department contacted the inspector a few days later and said that this work had not been done but the company responsible for this were visiting the home the following day to carry this out. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 X X 3 X 3 x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X x 2 Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The written care plans must be reviewed when residents needs change and where appropriate after consultation with the resident the plan revised and the resident notified of any such revision. The registered person must ensure that a summary of complaints during the preceding twelve months is kept at the home together with the action taken in response to the complaints. The bedside rails risk assessments must be sufficiently detailed to ensure that all aspects of risks have been considered. Timescale for action 06/09/06 2 OP16 22 06/08/06 3. OP38 13 06/08/06 Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP8 OP9 OP26 Good Practice Recommendations The manager should monitor staff practices regularly to ensure that bad practice is eliminated. A record of the quantity of medicines carried over from one month to the next should be made. The registered person should consider the provision of sluice machines in all units. Winsford Grange Care Home DS0000018743.V296268.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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